How does the adoption of digital health tools in primary care impact clinician-patient communication? Some lessons from the DECODE study into unintended consequences

Talk Code: 
Andrew Turner
Michelle Farr, Jon Banks, Rebecca Morris, Sarah Blake, Sue Ziebland, Emma Hyde, Fiona Stevenson, Lorraine McDonagh, Fiona Hamilton, John Powell, Helen Atherton, Gemma Lasseter, Sian Jones, Bob Golding, Gene Feder, Lucy Yardley, Jeremy Horwood
Author institutions: 
University of Bristol, University of Bristol, University of Bristol, University of Manchester, PPI collaborator, University of Oxford, University of Oxford, University College London, University College London, University College London, University of Oxford, University of Warwick, University of Bristol, West of England Academic Health Science Network, PPI collaborator, University of Bristol, Univ


Digital health tools, such as online consultation systems and platforms giving patients online access to their medical records, are becoming commonplace. NHS England advocates their use as an essential part of a cost-effective health service to support patient access and care. However, their rapid development and adoption in primary care may lead to unintended consequences (positive and negative) that alter healthcare processes and outcomes. The DECODE study aims to support the adoption of digital health tools in primary care by understanding their unintended consequences. Here we focus on how online consultation systems and online access to health records provide new ways for clinicians and patients to interact with each other, and the consequences this has for clinician-patient communication and relationships.


Semi-structured individual interviews with 21 patients, 15 general practice clinicians and 8 managerial and administrative staff involved in the use of three types of digital health tools (online consultations, patient online access to health records). Thematic analysis was used to analyse the data using NVivo 11 software for data management.


Our interviews highlight how these technologies can make clinician-patient communication more transactional, meaning information flows one-way, or only short question-and-answer exchanges take place. For some, this achieved the intended consequences of improving efficiency and access to care. For example, through patients being able to check test results and medical information online, or use online consultation systems to update the practice or receive answers to simple requests. However, the unintended consequences of this shift included patients being uncertain how to interpret information in their medical record, increasing pressure on patients in relation to how they describe their issues, and patients being unclear who they are communicating with, leading to uncertainty and distress. This could be seen to challenge the valued element in traditional clinician-patient relationships; namely personal contact and the opportunity to explore medical concerns.


Examining unintended consequences of digital tools that increase the scope and extent of transactional communication shows how prioritising convenience and access for some, can come at the expense of providing holistic, patient centered care for others. Developing an understanding of the unintended consequences of digital health tools is vital to aid their future successful implementation in primary care.

Submitted by: 
Andrew Turner
Funding acknowledgement: 
The DECODE study is funded by National Institute for Health Research (NIHR) School for Primary Care Research and supported by NIHR Applied Research Collaboration West (NIHR ARC West). The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health and Social Care